Chang Yu-Tang, Lee Jui-Ying, Chiu Wen-Chun, Hsin Yu-Mei, Chiu Chi-Shu
Department of Surgery, Kaohsiung Medical University Hospital, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Surg Laparosc Endosc Percutan Tech. 2011 Apr;21(2):e74-7. doi: 10.1097/SLE.0b013e31820ca3a4.
The endoscopic approach is a technical innovation for release of the sternocleidomastoid (SCM) fibrosis in muscular torticollis, where operation scars can be hidden at less conspicuous areas, for example, at the axilla and hair-bearing scalp. As the SCM muscle is located beneath the investing layer of deep cervical fascia which is reported to continue to the fascia of the pectoralis major, the aim of the study was to describe and evaluate the preliminary result of transaxillary subfascial approach for persistent muscular torticollis in children.
A total of 4 children (2 boys and 2 girls) were included in this study from January to December 2009. Using a 2-port endoscopic technique, the division of the lower end of the fibrotic SCM muscle was performed through the subfascial working cavern. The subfascial dissection was performed under the fascia of the pectoralis major and above the muscular fibers from ipsilateral axilla with the aid of a homemade dissection balloon.
The mean operating time was 67.5±11.9 minutes (range: 55 to 80 min). There was no serious operative morbidity and the mean follow-up period was 14.8±5.1 months (range: 9 to 20 mo). All patients had complete unrestricted movement of the head and no recurrence was observed during this period.
The transaxillary endoscopic technique, a working cavern created under the fascia of the pectoralis major, offers a safe and straightforward way to surgically manage persistent muscular torticollis while preserving neurovascular structures, exempting extradissection of noninvolved tissues and avoiding the potential for poor cosmesis from any neck scar.
内镜手术方法是一项技术创新，用于松解肌性斜颈中的胸锁乳突肌（SCM）纤维化，手术疤痕可隐藏在不太显眼的部位，例如腋窝和有毛发的头皮处。由于据报道胸锁乳突肌位于颈深筋膜的包绕层下方，该筋膜会延续至胸大肌筋膜，本研究的目的是描述和评估经腋窝筋膜下入路治疗儿童持续性肌性斜颈的初步结果。
2009年1月至12月，本研究共纳入4例儿童（2男2女）。采用双端口内镜技术，通过筋膜下工作腔对纤维化胸锁乳突肌下端进行切断。在自制的剥离球囊辅助下，于胸大肌筋膜下方、同侧腋窝肌纤维上方进行筋膜下剥离。
平均手术时间为67.5±11.9分钟（范围：55至80分钟）。无严重手术并发症，平均随访期为14.8±5.1个月（范围：9至20个月）。所有患者头部活动完全不受限，在此期间未观察到复发。
经腋窝内镜技术，即在胸大肌筋膜下创建工作腔，为手术治疗持续性肌性斜颈提供了一种安全、直接的方法，同时可保留神经血管结构，避免对未受累组织进行额外剥离，并避免颈部疤痕可能导致的美观问题。
